Admission billing codes in ER

One month ago, I wrote an entry about basic ER billing.

As a follow up, here is some clarification about admission codes.

There are three codes a ER doctor can use for the admission: H105, C004 and C933.

H105 is for "interim admission orders". In one ER I used to work in in the past, the ER docs would write the admission order, but would not dictate/write the admission note. Once the patient was brought up to the floor, the family doctor would dictate the admission note and would become "the most responsible physician." In this case, H105 ($18.10) would be an appropriate code to use. Think of it as the admission reassessment.

C004 is for an admission somewhat more involved. The ER doctor would write the admission orders, do the dictation for the admission note, but the patient would still be admitted under another doctor; the ER doctor is not going to follow during the admission.  Use C004 ($30.70) for such an admission.

C933 ($79.20) is for the case where you would admit the patient under yourself, and you will become the most responsible physician during the admission.

OHIP billing how-to for Internal Medicine

This blog is intended to teach the basics of OHIP billing for internal medicine specialists working in a hospital setting. Generally, as an internal medicine specialist, a patient will be referred to you for a consult. To bill for this first initial consult, you need to determine the following for your initial consult:
 
Location (where did your initial consult take place?): ER; Ward
Type (the type of consult): General; Comprehensive; Limited; Repeat (there are others)
Time (time of day you did the consult): Weekday 7:00-17:00; Weekday 7:00-17:00 during Office Hours; Evening Weekday 17:00-24:00; Weekend/Holidays 7:00-24:00; Nights 00:00-7:00
Travel (did you have to travel to go see the patient): Yes; No

Depending on your answers from above we can determine which fee codes to bill to the Ministry of Health for the initial consult. Using your answers follow the breakdown below to find out which codes you need to bill. The first half is for ER visits while the second half covers Ward visits.  

If ER is chosen as location and…

·Type is:            

o   General = A135A

o   Comprehensive= A130A

o   Limited= A435A

o   Repeat= A136A

· Time is: 

o if Travel=YES (if you had to travel then no matter the time of day you can bill for your travel and first person seen premiums shown below, known as your special visit premiums)

§  Weekday 7:00-17:00 = K960A, K990A

§   Weekday 7:00-17:00 during Office Hours = K961A, K992A

§  Evening Weekday 17:00-24:00 = K962A, K994A

§  Weekend/Holidays 7:00-24:00 = K963A, K998A

§   Nights 00:00-7:00 = K964A, K996A

o   if Travel=NO (if you did  not travel then you can only bill for your first person seen premium shown below; however if you saw the patient during the week from 7:00-17:00 you can't bill for the first person seen premium)

§  Weekday 7:00-17:00: nothing

§   Weekday 7:00-17:00 during Office Hours: K992A

§  Evening Weekday 17:00-24:00: K994A

§  Weekend/Holidays 7:00-24:00: K998A

§   Nights 00:00-7:00: K996A

· If you admitted the patient add: E082A

 
If Ward is chosen and…
 

·Type is: (Use these codes, but if both Travel=NO and Time=Weekday 7:00-17:00, use the codes listed after this)            

o   General = A135A

o   Comprehensive= A130A

o   Limited= A435A

o   Repeat= A136A
 

·Type if Travel=NO and Time=Weekday 7:00-17:00: (Essentially all your codes listed above now start with 'C' instead of 'A')

o   General = C135A

o   Comprehensive= C130A

o   Limited= C435A

o   Repeat= C136A

·Time is:

o   if Travel=YES (if you had to travel then no matter the time of day you can bill for your travel and first person seen premiums shown below, known as your special visit premiums)

§  Weekday 7:00-17:00: C960A, C990A

§   Weekday 7:00-17:00 during Office Hours: C961A, C992A

§  Evening Weekday 17:00-24:00: C962A, C994A

§  Weekend/Holidays 7:00-24:00: C963A, C986A

§   Nights 00:00-7:00: C964A, C996A

o   if Travel=NO (if you did  not travel then you can only bill for your first person seen premium shown below; however if you saw the patient during the week from 7:00-17:00 you can't bill for the first person seen premium)

§  Weekday 7:00-17:00: nothing

§   Weekday 7:00-17:00 during Office Hours: C992A

§  Evening Weekday 17:00-24:00: C994A

§  Weekend/Holidays 7:00-24:00: C986A

§   Nights 00:00-7:00: C996A

That covers your fee codes for the initial visit with the patient. Now what happens if you continue to visit the patient daily until they are discharged?

You can use the following fee codes scheme:

Initial visit: determined using the logic above

Day after admission: C122A + E083A (The E083A is the premium if you are the most responsible physician for the patient)

Day 2 after admission: C123A +E083A

From Day 3 after admission to discharge: (Note that you use a different code for these subsequent visits, depending on when you are seeing the patient relative to their admission date. There are restrictions on how many times you can use C137A and C139A).

-          C132A (if 5 weeks from admission) +E083A

-          C137A (if 6-13 weeks from admission) + E083A

-          C139A (if past 13 weeks from admission) + E083A

Discharge: C124A + E083A

Our Mo-Billing app actually auto-generates all these codes for you given you provide the admission date, the first day you saw the patient, the last day you saw the patient and whether this was the day of discharge and the location, type, time and travel of the initial consult. To help with the understanding here are 3 examples right from our Mo-Billing app:

Example 1

 

Admission Date: Feb 15 2014

First Seen Date: Feb 15 2014 (Day of initial consult, the first day you saw the patient)

Last Seen Date: Feb 20 2014 (Last date you saw the patient, it is also the discharge date)

Enable autogeneration of codes: activated

Location: ER

Type: General

Time: Weekday 07:00-17:00

Travel: Yes

 

 

Feb 15 2014 : A135A (ER and General), K960A, K990A (ER, Weekday 07:00-17:00, Travel=YES), E082A

Feb 16 2014: C122A , E083A (day1 after admission)

Feb 17 2014: C123A, E083A (day2 after admission)

Feb 18 2014: C132A, E083A (I know to use the code for within 5 weeks from admission code since Feb 18 2014 is only 3 days after the date of admission so it falls within this category. If the date was  April 5 2014 then I would use the code C137A, E083A since this date falls within 6-13 weeks after the admission date)

Feb 19 2014: C132A, E083A

Feb 20 2014: C124A, E083A (since the last seen date is the same as discharge otherwise I would use C132A again)

 

Claim Example 2

 

Admission Date: Feb 15 2014

First Seen Date: April 15 2014 (first day you saw the patient, not the same as admission date)

Last Seen Date: April 20 2014 (last day you saw the patient, not the discharge date)

Enable autogeneration of codes: activated

Location: Ward

Type: Comprehensive

Time: Nights 00:00-07:00

Travel: No

 

 

April 15 2014 : A130A (Ward, Comprehensive, Travel=NO), C996A (Ward, Nights 00:00-07:00, Travel=NO)

April 16 2014: C137A , E083A (I know to use the code for within 6-13 weeks from admission since April 16 2014 is 8 weeks and 3 days after the date of admission so it falls within this category. If the date was  Sept 5 2014 then I would use the code C139A, E083A since this date falls after 13 weeks from the admission date)

April 17 2014: C137A, E083A 

April 18 2014: C137A, E083A

April 19 2014: C137A, E083A

April 20 2014: C137A, E083A (since the last seen date is not the same as discharge)

 

Claim Example 3

 

Admission Date: Feb 15 2014

First Seen Date: Feb 15 2014 (first day you saw the patient, the same as admission date)

Last Seen Date: Feb 15 2014 (last day you saw the patient, the same as discharge date)

Enable autogeneration of codes: activated

Location: Ward

Type: Repeat

Time: Weekday 7:00-17:00

Travel: No

 

 

Feb 15 2014 : C136A (Ward, Repeat, Travel=No)

Note: All this information was obtained from documents made publicly available by the MOHLTC. We are not to be held liable for any occurrences that arise from following our understanding of  medical billing.
  

 
 

Heartbleed scare

Recently, there has been quite a talk about openSSL vulnerability called "Heartbleed". We are well aware of the situation. Our servers are well managed with extra level of security and problematic software is fully patched already. Here is a quote from the server manager:

"Like hundreds of other companies, we were using the affected versions of OpenSSL on our servers. However, none of our servers are accessible from the internet without going through load balancers. This means that even if our load balancers were the target of an attack, none of the code, keys or passwords would be compromised.

All of our servers, load balancers and CDN servers are now fully patched and protected against this security vulnerability.

We also have no reason or evidence to believe that any part of our infrastructure has been exploited for this vulnerability.

However, to avoid any potential risks, we have replaced all of our SSL keys and certificates to ensure no traffic is compromised between our customers and our servers."

We will keep monitoring the situation but at this point, there is no interruption to our service.

New Regulations on Crowdfunding

Last night Capital News reached out to us to get our opinion, as a startup, on the new regulations on crowdfunding. A short piece of our opinion was shared through Capital News, so I thought I would expand on our opinion found in their article New crowdfunding regulations bring opportunities for startups.

The new crowdfunding regulations are exciting for startups, primarily because it gives us greater access to funding and expands our investment opportunities. Crowdfunding provides startups with a whole new source of funding, allowing startups to tap into something new, something untouched- which may be exactly what some need to provide them with a quick kickstart. In addition to expanding access to funding, investment opportunities are expanded as well. Through a portal startups are able to connect with investors they may have never had the opportunity to approach, potentially because they simply didn't know of them. Crowdfunding will function to facilitate capital fundraising for startups in terms of access and effort; apparently the documents startups are required to prepare for the investors require a lot less effort than the traditional approach to investment funding.

The only precaution for startups: through a portal you may not have the opportunity to get to know the person investing into your company- and this may be worrisome is they all of a sudden own equity in your company.

Why hospital group practices are interested in Mo-Billing app

We are seeing more interesting development with Mo-Billing; we are negotiating deals with departments in three separate large hospitals in Ontario. One group has started trialing already.

These departments have group practices where doctors share admin resources including the billing clerks. The feedback from the billing clerks so far are unanimous and also consistent with the opinion of other billing agents.

They are excited about getting rid of paper with doctor's hand written information on it. The data is available as soon as the claim is submitted with clear photos. There are no excuse or confusion about lost claim cards. No more faxing, no more filing physical paper.

However, one thing we are surprised with is that, some of these group practices were using courier services to pick up and drop off the stack of claim cards.  Their admin office is often physically located away from the actual hospital, or one admin office is shared between multiple campuses. They are excited with the prospect of eliminating this expense; and one less logistical headache! One less intermediary to lose paper!

We are very excited with on-going adoption of our technology among doctors.